摘要
目的探讨采用一期病灶清除闭式冲洗引流治疗腰椎内固定术后感染的临床疗效。方法 2002年6月-2008年3月,收治12例腰椎内固定术后感染患者。男9例,女3例;年龄35～68岁,平均48.5岁。内固定术后7～183d出现感染,平均56d。内固定节段:单节段7例,均为L4、5;双节段4例,其中L4、5及L5、S12例,L3、4及L4、52例;三节段1例,为L3、4、L4、5及L5、S1。采用一期病灶清除、闭式冲洗引流治疗,其中2例取出内固定物。结果残余椎间盘细菌培养结果显示,金黄色葡萄球菌8例,阴沟肠杆菌3例,阴性1例。术后切口均Ⅰ期愈合。12例均获随访,随访时间18～53个月,平均34.7个月。术后白细胞计数、红细胞沉降率及C反应蛋白均下降,术后15d时各指标与术前比较,差异均有统计学意义(P<0.05)。随访期间均无明显腰部疼痛。X线片示病变椎间隙均融合;未取出的内固定物无移位及断裂,2例取出内固定物者均未再次行内固定术;术后18个月时脊柱后凸角较术前平均改善0.8°。末次随访时疼痛视觉模拟评分为(2±1)分,与术前(10±2)分比较差异有统计学意义(P<0.05)。结论一期病灶清除联合闭式冲洗是治疗腰椎内固定术后感染的有效方法之一,能迅速缓解腰痛症状,手术操作简便,住院时间短。
Objective To investigate the clinical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3 females and aging 35-68 years （48.5 years on average）. The disease duration varied from 7 days to 183 days （56 days on average）. The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 （2 cases）, and L3, 4, L4, 5 （2 cases）, and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months （34.7 months on average）. The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation （P〈0.05）. No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference （P〈0.05） when compared with that （10 ± 2） before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第9期1088-1091,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
腰椎内固定术
术后感染
病灶清除
闭式冲洗
Lumbar instrumentation Postoperative infection Debridement Closed-suction drainage
